Development Application for permit to damage vegetation - OPW13/0609

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Privacy-the information collected in this form will be used by the Department of Infrastructure and Planning (DIP)in
accordance with the processing and assessment of your application. Your personal details will not be disclosed for a purpose
outside of the IDAS process, except where required by legislation (including the Right to Information Act 2009) or as required

by Parliament. This information may be stored in a departmental database. The information collected will be retained as
required by the Public Records Act 2002.
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                                               Council. I have lDeen engaged as the private certifier for the building work referred
                                           _
                              _   __




                                               to in this application




                                                                                                               Building
Date of engagement         Name                                            BSA Certification license number
                                                                                                               c1assification/s




QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)
                                                                                             Date receipted

                                  QLeave Project             Amount paid                     form sighted by   Name of officer who
Description of the work                                                        Date paid
                                  Number                     ($)                             assessment        sighted the form
                                                                                             manager




 The Sustainable PlanningAct 2009(SPA)is administered by the Department of Infrastructure and Planning. This form and
 all other required application materials should be sent to your assessment manager and any referral agencies.



               7                                                                              Application details-IDAS form 1
                                                                                                Version 1.0 18December 2009